| NPI | 1801140512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60935555) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH70944) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2023-06-09 |